A stethoscope sits on an examination table in an exam room at a Community Clinic Inc. health center in Takoma Park, Maryland, April 8, 2015. 
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The trouble with Trump’s controversial choice to oversee Medicaid


One of the unsettling staples of Donald Trump’s presidency is his habit of tapping officials to lead agencies whose work they fundamentally oppose. As regular readers know, prominent cabinet-level officials like Rick Perry, Betsy DeVos, Scott Pruitt, Mick Mulvaney, and others have been asked to oversee departments that, in their minds, shouldn’t even exist.

We appear to have a new addition to the list. The Associated Press reported late yesterday:

President Donald Trump has tapped a Maine official who battled Medicaid expansion for a position that puts her in charge of the national program, the federal agency confirmed Monday.

Mary Mayhew’s role of deputy administrator and director of the U.S. Center for Medicaid and the CHIP Services will place her in charge of the federal health care program for low-income people.

Seema Verma, the head of the U.S. Centers for Medicare and Medicaid Services, confirmed the hire and cited Mayhew’s work as commissioner of Maine’s Department of Health and Human Services under Republican Gov. Paul LePage.

Mayhew’s tenure on Paul LePage’s team impressed health care opponents, but for everyone else, it was cause for concern. She spent several years condemning the Affordable Care Act, rejecting Medicaid expansion – despite the policy’s strong, bipartisan backing in Maine – and taking steps to impose new eligibility restrictions on the existing Medicaid program.

She also used her position in Maine to lobby other states not to implement Medicaid expansion through the ACA. It wasn’t part of Mayhew’s job description to advise other states, but she took it upon herself to urge policymakers elsewhere not to expand coverage to millions of low-income families far from Maine’s borders.

Mayhew parlayed her work into a gubernatorial campaign, though she finished a distant third in a Republican primary.

At that point, she was in the market for a new gig. Donald Trump thought it’d be a good idea to put her in charge of overseeing Medicaid – a program Mayhew has demonstrated a fair amount of hostility toward.

Ezra Klein suggested yesterday that a personnel move like this one suggests the White House is “launching a full-scale assault on Medicaid,” and under the circumstances, it’s tough to disagree.

Of course, given that Medicaid is the nation’s largest single health care provider, that’s a risky thing for a Republican to do three weeks before Election Day, but it’s likely that Trump is counting on the public not hearing about this.